The following LPG Weekly Health Care Watch provides a summary update of legislative and regulatory health care activities from March 8 – 15­.  Where available, hyperlinks are included to the relevant documents. Please let us know if you have any questions or would like additional information on the items below.

LEGISLATIVE UPDATE

Senate   

·       On March 11, the Senate Finance Committee (SFC) held a markup to consider the nomination of Sarah C. Arbes to replace Matthew Bassett as the Assistant Secretary of Health & Human Services (HHS). The Committee voted 28-0 to advance her nomination to the Senate. 

House

·         On March 10, the Appropriations Labor, HHS, Education & Related Agencies Subcommittee held a hearing entitled Centers for Disease Control & Prevention (CDC) Budget Request for FY 2021. COVID-19 was discussed often at the hearing. Subcommittee Chair Rosa DeLauro (D-CT) claimed the outbreak is a reminder of the importance of a well-trained, well-lead, well-trusted, and well-funded public health workforce. Therefore, she claimed the Subcommittee will not pursue the 9% funding cut included in the President’s FY 2021 budget request. Subcommittee Ranking Member Tom Cole (R-OK) agreed that the Subcommittee “will not be reducing CDC’s budget anytime soon.” Witnesses included: Ileana Arias, Associate Deputy Director for Public Health Science & Surveillance; Sherri Berger, Chief Strategy Officer & Chief Operating Officer; and Robert Redfield Director, CDC.

·       On March 11, the Appropriations Agriculture, Rural Development, Food & Drug Administration (FDA), and Related Agencies Subcommittee held a hearing entitled FDA Budget Request for FY2021. The President’s budget requests $6 billion in total resources for FDA, a 4.5% increase compared to the FY 2020 enacted level. Lawmakers focused their comments on the public threat created by COVID-19, including the vulnerabilities of the U.S. drug supply chain and effort to boost domestic manufacturing. FDA Commissioner Stephen Hahn outlined his three priorities for the FDA under his leadership, including 1) leveraging the power of data to improve FDA’s role as regulator, 2) empowering patients and consumers to be more informed about the products FDA oversees, and 3) promoting innovation, choice, and competition in the drug market. Commissioner Hahn was the sole witness. 

·       On March 11, the Energy & Commerce Health Subcommittee held a markup on 13 measures, all of which were favorably reported to the full committee. 

  • H.R. 5279, the Cosmetic Safety Enhancement Act of 2019, which would require cosmetics manufacturers to register their facilities and comprehensive cosmetic ingredient statements with the FDA;

  • H.R. 5668, the Making Objective Drug Evidence Revisions for New (MODERN) Labeling Act of 2020, which gives authority to FDA to require modifications of outdated labeling for generic drugs;

  • H.R. 5663, the Safeguarding Therapeutic Act, a bill to allow FDA to destroy certain imported medical devices in instances where FDA believes such medical devices are adulterated, misbranded, or unapproved and may pose a threat to the public health;

  • H.R. 4866, the National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act of 2019, a bill to direct FDA to designate National Centers of Excellence in Continuous Pharmaceutical Manufacturing to work with FDA and industry to craft a national framework for continuous manufacturing implementation;

  • H.R. 4712, the Fairness in Orphan Drug Exclusivity Act, a bill to require drug manufacturers seeking orphan drug designations to demonstrate the absence of any reasonable expectation of recovering the costs they incur in developing and making those drugs available in the U.S. for such disease or condition;

  • H.R. 2117, the Food Allergy Safety, Treatment, Education & Research (FASTER) Act of 2019, a bill to would require the CDC to expand the collection of information regarding the prevalence of food allergies for specific allergens and to report such information to Congress;

  • H.R. 2468, the School-Based Allergies and Asthma Management Program Act, a bill to increase the preference given, in awarding certain allergies and asthma-related grants, to states that require certain public schools to have allergies and asthma management programs;

  • H.R. 2271, the Scarlett’s Sunshine on Sudden Unexpected Death Act, a bill to improve the health of children and help better understand and enhance awareness about unexpected sudden death in early life;

  • H.R. 4801, the Healthy Start Reauthorization Act of 2019, a bill to reauthorize the Healthy Start program;

  • H.R. 1379, the Ensuring Lasting Smiles Act, a bill to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a congenital anomaly or birth defect;

  • H.R. 2477, the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act of 2019, a bill to establish a system to notify individuals approaching Medicare eligibility and to simplify and modernize the eligibility enrollment process;

  • H.R. 5534, the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act, a bill to extend Medicare coverage of immunosuppressive drugs beyond 36 months for kidney transplant patients that are unable to obtain health care coverage elsewhere; and

  • H.R. 3935, the Protecting Patients Transportation to Care Act, a bill to codify in statute the nonemergency transportation benefit under Medicaid (currently this is a mandatory benefit established through regulation.

·         On March 12, the Veterans’ Affairs Committee held a markup to reauthorize the Women Veterans Task Force and vote on pending legislation. All measures were favorably reported to the House.

  • H.R. 712, VA Medical Cannabis Research Act, a bill to create a VA trial on cannabis use for chronic pain and post-traumatic stress disorder;

  • H.R. 1647, Veterans Equal Access Act, to authorize VA health care providers to provide recommendations and opinions to veterans regarding participation in state marijuana programs;

  • H.R. 3798, Equal Access to Contraception for Veterans Act, to provide for limitations on copayments for contraception furnished by the VA;

  • H.R. 2816, Vietnam Era Veterans Hepatitis-C Testing Enhancement Act, to carry out a pilot program to increase access to hepatitis C testing for Vietnam-era veterans;

  • H.R. 2628, VET CARE Act, to establish a pilot program for the provision of dental care to certain veterans; and

  • H.R. 1527, Long Term Care Veterans Choice Act, to authorize the Secretary of Veterans Affairs to enter into contracts and agreements for the placement of veterans in non-Department medical foster homes for certain veterans who are unable to live independently.

·         Staff for the Committees on Education & Labor, Energy & Commerce, and Ways & Means continue to meet with the hopes of reconciling their surprise medical billing legislation with the goal of moving a unified by bill before May 22.

·         House Democrats are expected to release an Affordable Care Act expansion bill to coincide with the 10-year anniversary of the law on March 23.  The bill is expected to provide moderate Democrats with an alternative to Medicare for All.  The plan is rumored to expand subsidies beyond 400% of the federal poverty level while also increasing the value of the existing subsidies. 

REGULATORY UPDATE

·       On March 9, HHS finalized two interoperability rules that overhaul how providers, insurers, and patients exchange health data. The first rule, issued by the Office of the National Coordinator (ONC), requires health IT vendors to make patient data downloadable using a standardized Application Programming Interface (API), known as the Fast Healthcare Interoperability Resources (FHIR). The second rule, issued by the Centers for Medicare & Medicaid Services (CMS), requires health plans in Medicare Advantage, Medicaid, CHIP, and the federal exchange to do the same while also requiring hospitals to send electronic admissions, discharge, transfer notifications to primary care providers. More information on the rules is available here. 

·       On March 9, the FDA held a meeting to discuss ways the FDA and Federal Trade Commission (FTC) can help biosimilars compete with biologics. A top question was whether FTC should take antitrust action against biologic manufacturers that use false advertising to deter biosimilar competition.

·       On March 10, the Texas House delegation sent a letter to CMS Administrator Seema Verma expressing its concern with the Agency’s proposed Medicaid Fiscal Accountability Rule (MFAR), which seeks to change how states can acquire supplemental Medicaid dollars.  Specifically, the 36-member delegation claimed “the new conditions proposed by CMS would prohibit the existing approved methods of finance and create ambiguity for the Texas Medicaid program in the future.” However, the members supported the transparency portions of the proposed rule.

·       On March 11, the CMS Innovation Center unveiled the “Part D Senior Savings Model,” a voluntary demonstration aimed at capping Part D enrollees’ cost-sharing for insulin at $35 per month. Drug manufacturers would still be required to provide a 70% discount on branded drugs during the coverage gap; however, such discounts would be calculated before the application of supplemental benefits.  To encourage participation, the model offers Prescription Drug Plans (PDP) additional risk corridor protection for CYs 2021-2022. CMS predicts beneficiaries who rely on insulin and are enrolled in a participating plan would save an average of $446 a year in out-of-pocket (OOP) costs. CMS also estimates over $250 million in savings over five years for the federal government, largely due to drug manufacturers paying additional discounts.  Manufacturers must apply to participate in the model by March 18, and Part D sponsors must apply to participate by April 10.  The model will begin January 1, 2021.

·       On March 13, the FDA finalized guidance describing the process that generic drug applicants should follow to request designation of a drug as a Competitive Generic Therapy (CGT). Since the CGT category was established in 2017, FDA has received more than 350 requests under the pathway but only approved 31. Commissioner Hahn said that by “providing incentives for the development of generic versions of drugs that currently face little or no competition,” the CGT pathway should “result in increased access to necessary treatments and potentially lower the cost of these medications.”

CORONAVIRUS UPDATE

·       On March 9, 2,400 passengers aboard the Grand Princess cruise ship off the California coast were sent to quarantine and treatment sites after 19 crew members and two passengers were diagnosed with COVID-19. President Donald Trump reportedly wanted infected passengers to stay on the ship to reduce further spread, though public health officials maintained that quickly removing all passengers was the safest option.

·       On March 9, leaders of the Energy & Commerce Committee sent FDA Commissioner Hahn a letter requesting a briefing on the Agency’s efforts to mitigate shortages of medical supplies, devices, and drugs amid the COVID-19 outbreak.

·       On March 9, the FDA and the Federal Trade Commission (FTC) issued warning to seven companies selling fraudulent products that claim to treat COVID-19.

·       On March 9-10, CMS sent a series of guidances to State Survey Agencies (SSAs) to inform various providers on how to respond to COVID-19, including hospitals, nursing homes, hospice agencies, home health care agencies, and dialysis facilities. 

·       On March 10, CMS sent a guidance to SSAs clarifying the types of facemasks that can temporarily be used when treating patients with COVID-19 and other respiratory infections.  The guidance aims to align facemask policies across CMS, CDC, and FDA. 

·       On March 10, CMS issued guidance to MA plans, Part D sponsors, and Medicare-Medicaid Plans to inform them of their obligations and flexibilities related to disasters and emergencies resulting from COVID-19. Notably, CMS is waiving cost-sharing for COVID-19 tests in physician offices, telehealth, and emergency rooms; removing prior authorizations requirements; waiving prescription refill limits; relaxing restrictions on home or mail delivery of prescription drugs; and expanding access to certain telehealth services.

·       On March 10, New York Gov. Andrew Cuomo (D) issued travel instructions in New Rochelle, a New York City suburb where several COVID-19 cases were confirmed. He also banned all gatherings of 500 people or more, effective March 13.

·         On March 10, the Small Business Committee held a hearing entitled the Impact of Coronavirus on America’s Small Businesses. Chair Nydia Velazquez (D-NY) maintained that small businesses have already begun to suffer because of COVID-19. She supported a provision in the $8.3 billion emergency funding package to allow small businesses to access federal loans if they suffer losses because of the pandemic. Witnesses included: Jennifer Huang Bouey, Senior Policy Researcher, Tang Chair in China Policy Studies, RAND Corporation; Jay Ellenby, American Society of Travel Advisors; Andrew Chau, Co-Founder & CEO, Boba Guys; and Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, Professor, Seton Hall University.

·       On March 11, the Oversight & Reform Committee held a hearing entitled Coronavirus Preparedness and Response. Lawmakers were eager to know how many Americans are projected to contract the virus; in response, National Institute of Allergy & Infectious Diseases (NIAID) Director Anthony Fauci maintained that the total number of infected patients depends on the response: “if we are complacent and do not do really aggressive containment and mitigation, the number could go way up and be involved in many, many millions.” Fauci estimated that COVID-19 is 10x more deadly than the flu and admitted that the lag in diagnostic testing has compromised containment efforts. Additionally, CDC Director Redfield claimed the greatest threat to the U.S. is currently people coming into the country from Europe.  Witnesses included: Anthony Fauci, Director, NIAID, National Institutes of Health (NIH); Robert Redfield, Director, CDC; Robert Kadlec, Assistant Secretary Preparedness & Response (ASPR); Terry Rauch, Acting Deputy Assistant Secretary of Defense for Health Readiness Policy & Oversight, Department of Defense; and Chris Currie, Director, Emergency Management & National Preparedness, Government Accountability Office (GAO).

·       March 11, the Homeland Security Emergency Preparedness, Response & Recovery Subcommittee held a hearing entitled Community Perspectives on Coronavirus Preparedness and Response. Subcommittee Chair Lauren Underwood (D-IL) claimed a strong federal response must include 1) continued support for local and state public health departments, hospitals, and emergency responders; 2) patient protections from health care costs associated with COVID-19; and 3) efforts to soften the economic impact of the crisis on families and small businesses. Witnesses included: Ken Cuccinelli, Acting Deputy Secretary, U.S. Department of Homeland Security (DHS); and Gary Rasicot, Acting Assistant Secretary, Countering Weapons of Mass Destruction Office, DHS.

·       On March 11, the Internal Revenue Service (IRS) issued guidance allowing high deductible employer sponsored health plans to cover the cost of COVID-19 testing and treatment. Absent the notice, it would have been illegal for high deductible plans with health savings accounts to waive cost sharing obligations for patients that have not met their deductible. 

·       On March 11, the FDA suspended routine inspections of food, drugs, and medical devices manufactured overseas until the end of April. The Agency has already paused such facility inspections in China. FDA will still consider conducting critical inspections on a case-by-case basis.

·       On March 11, the World Health Organization (WHO) increased its classification of COVID-19 from an outbreak to a pandemic, pointing to “alarming levels of spread and severity and alarming levels of inaction.” Additionally, the WHO touted aggressive containment steps taken by China and the Republic of Korea; both countries now have declining epidemics. The WHO reiterated that “all countries can still change the course of this pandemic.”

·       On March 11, President Trump addressed the nation on COVID-19. He announced that all travel from 26 European countries, including trade and cargo, will be suspended for at least 30 days, effective March 13. He also declared that health insurers would cover all COVID-19 treatments and waive all patient cost sharing obligations, including for office visits. However, America’s Health Insurance Plans (AHIP) later clarified that insurers will fully cover testing, not treatment. Regarding an economic stimulus package, the President proposed creating low interest loans for small businesses, deferring tax payments for affected businesses and individuals, and reducing payroll taxes. The next day, it was reported that the President is considering leveraging authority under the Stafford Act to unlock billions of dollars to mitigate the economic consequences of the pandemic.

·       On March 11, Vice President Mike Pence and other White House officials met with representatives from the hospital industry to discuss the effect COVID-19 will have on providers. Executives from the American Hospital Association, Federation of American Hospitals, and HCA Health Care were among those who attended. 

·       On March 11, Senate Democrats outlined an economic relief package.

·       On March 11, Rep. Jan Schakowsky (D-IL) and Sen. Richard Blumenthal (D-CT) sent HHS Secretary Alex Azar and CMS Administrator Seema Verma a letter requesting stronger nursing home infection requirements.  At least 20 nursing home residents in the Seattle region died because of COVID-19.

·       On March 12, it was reported that Dr. Brian Monahan, the attending physician of the U.S. Congress, told Capitol Hill staffers at a closed-door meeting that he expects 70-150 million people in the U.S. (roughly a third of the country) to contract COVID-19.

·       On March 12, California Gov. Gavin Newsom (D) issued an executive order halting public gatherings and offering workers and taxpayers relief from the impact of COVID-19.

·       On March 12, Majority Leader Mitch McConnell (R-OK) delayed the Senate’s recess scheduled for the week of March 16 to work on legislation to combat the pandemic and mitigate economic fallout.

·       On March 12, the HHS Office of the Secretary released a notice of declaration to provide liability immunity for activities related to medical countermeasures against COVID-19.

·       On March 12, FDA approved Roche Holding AG’s diagnostic test, allowing over 100 laboratories with access to Roche’s testing machines to deploy the tests immediately. Roche’s testing machines can produce results within just three hours and process 4,128 samples within one day. Testing capacity continues to be the limiting factor in U.S. efforts to contain the outbreak.

·       On March 12, CMS shared payment information for COIVD-19 testing with Medicare Administrative Contractors.

·       On March 13, President Trump tapped Adm. Brett Giroir to serve as the testing “czar” to coordinating testing efforts among public health service agencies.

·       On March 13, the FDA announced it will allow New York state to authorize public and private labs to begin testing.

·       On March 13, over 100 Democrats sent Secretary Azar a letter calling for HHS to establish a Special Enrollment Period for patients to seek ACA Marketplace coverage during the COVID-19 pandemic. They argue that patients without health coverage are unlikely to seek treatment and testing, promoting further spread.

·       On March 13, President Trump declared a national emergency, unlocking up to $50 billion in additional funding. He also called on hospitals to activate their emergency preparedness plans and announced a plan for widespread drive-through testing. He claimed an additional 1.4 million new tests will be made available by next week and five million by month’s end.

·       On March 14, the House voted 343-40 to pass H.R. 6201, the Families First Coronavirus Response Act. The multibillion stimulus package guarantees free COVID-19 testing, secures paid emergency leave, enhances unemployment Insurance, strengthens food security initiatives, and increases federal Medicaid funding to states. The package was introduced by Speaker Nancy Pelosi (D-CA) on March 12 and was subject to intense negotiations with Treasury Secretary Steven Mnuchin.  As passed, the bill reflects bipartisan agreement between House Democrats and the Trump administration. The House is expected to pass a technical corrections bill by unanimous consent early during the week of March 16.  The Senate is expected to approve the bill shortly after receiving it from the House. A summary is available here.

·       On March 14, the White House physician confirmed that President Trump tested negative for COVID-19.  The President took the test on March 13, and he remains symptom-free one week after dining with a Brazilian government delegation, some of whose members have tested positive for COVID-19.

RULES AT THE WHITE HOUSE OFFICE OF MANAGEMENT & BUDGET (OMB)

Pending Review

HHS-CMS

  • Conditions for Coverage for End-Stage Renal Disease Facilities—Third Party Payments (CMS-3337-P); Proposed Rule; Received 6/6/2019

  • International Pricing Index Model for Medicare Part B Drugs (CMS-5528-P); Proposed Rule; Received 6/20/2019

  • Medicare Coverage of Innovative Technologies (CMS-3372-P); Received 7/30/2019

  • Medicaid & CHIP Managed Care (CMS-2408-F); Final Rule; Received 9/26/2019

  • Strengthening the Program Integrity of the Medicaid Eligibility Determination Process (CMS-2421-P); Proposed Rule; Received 12/20/2019

  • Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value Based Payments (VBP) for Drugs Covered in Medicaid (CMS-2482-P); Proposed Rule; Received 12/27/19

  • Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals; the Long-Term Care Hospital Prospective Payment System; and FY 2021 Rates (CMS-1735); Proposed Rule; Received 1/30/20 

  • Strengthening Oversight of Accrediting Organizations (AO) and Preventing AO Conflict of Interest, and Related Provisions (CMS-3367); Proposed Rule; Received 2/18/20

  • FY 2021 Skilled Nursing Facility (SNFs) Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1737); Proposed Rule; Received 2/24/20

  • FY 2021 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1729); Proposed Rule; 2/24/20

  • FY2021 Hospice Wage Index, Payment Rate Update, and Quality Reporting Requirements (CMS-1733); Proposed Rule; Received 3/3/20

  • FY 2021 Inpatient Psychiatric Facilities Prospective Payment System Rate and Quality Reporting Updates (CMS-1731); Proposed Rule: Received 3/4/20

  • Specialty Care Models to Improve Quality of Care and Reduce Expenditures (CMS-5527); Proposed Rule; Received 3/11/20

  • Amendments to the HHS-operated Risk Adjustment Data Validation under the Patient Protection and Affordable Care Act's (ACA) HHS-operated Risk Adjustment Program (CMS-9913); Proposed Rule; Received 3/11/20 

  • Treatment of Medicare Part C Days in the Calculation of a Hospital's Medicare Disproportionate Patient Percentage (CMS-1739); Proposed Rule; Received 3/12/20

HHS-IHS

  • CY 2020 Reimbursement Rates; Notice; Received 3/2/20

HHS-OIG

  • Civil Monetary Penalties Law Notice of Proposed Rulemaking; Proposed Rule; Received 1/23/20

HHS-HRSA

  • Reimbursement of Travel and Subsistence Expenses toward Living Organ Donation Program Eligibility Guidelines; Notice; Received 11/8/2019

REPORTS 

Congressional Budget Office (CBO)

·       On March 13, released a cost estimate of a revised version of S.2543, the Prescription Drug Pricing Reduction Act of 2019. CBO predicts the package, authored by SFC Chairman Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR), would reduce federal spending by roughly $95 billion over the 2020-2030 period. Among Part D enrollees who are not covered by the Low-Income Subsidy program, CBO expects the bill would reduce OOP spending by about $72 billion and premiums by about $1 billion over the 10-year period. Legislative text of the revised measure is expected to be released shortly now that a score has become available.

Government Accountability Office (GAO) 

·       On March 13, the GAO published a report entitled Medicare & Medicaid: Alignment of Managed Care Plans for Dual-Eligible Beneficiaries. The report describes what is known about states’ experiences with aligned enrollment in Dual-Eligible Special Needs Plans (D-SNPs) and examines CMS’ oversight of aligned enrollment. GAO recommends that CMS work to collect quality information on the experiences of dual-eligible beneficiaries who have been automatically enrolled into D-SNPs.

HHS Office of Inspector General (OIG)

·       On March 9, OIG posted a report entitled Comparison of Average Sales Prices (ASP) and Average Manufacturer Prices (AMP): Results for the Third Quarter of 2019. OIG is statutorily bound to compare ASP with AMP and if they conclude that the ASP for a drug exceeds the AMP by at least 5%, then the HHS Secretary must substitute the ASP amount with a lower calculated rate. OIG found that in the third quarter of 2019, 11 drug codes met this price substitution criteria. CMS is required to review the report and determine whether to pursue price substitutions to limit excessive payments for Part B drugs.

·       On March 10, OIG released a report entitled Florida Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness. OIG concludes that Florida did not ensure that nursing homes participating in the Medicare or Medicaid programs complied with CMS and State requirements for life safety and emergency preparedness. Of the 20 nursing homes OIG visited between July and November 2018, all had deficiencies related to life safety or emergency preparedness.

·       On March 10, OIG released a report entitled Key Medicare Tools to Safeguard Against Pharmacy Fraud and Inappropriate Billing Do Not Apply to Part D. According to their report, it is critical to keep out providers (including pharmacies) that pose risk to the program in order to safeguard Medicare against fraud and inappropriate billing. However, CMS’s three key tools for doing so—enrollment, revocation, and preclusion—apply to pharmacies when they bill Parts B or C, not when they bill Part D. OIG continues to recommend expanded these tools to Part D. 

·       On March 10, OIG released a report entitled Substance Abuse and Mental Health Services Administration’s (SAMHSA) Oversight of Accreditation Bodies for Opioid Treatment Programs (OTPs) Did Not Comply With Some Federal Requirements. OIG claims that SAMHSA performed inspections at selected opioid treatment programs (OTPs) but did not 1) meet its goal for the number of OTPs it would inspect, 2) take actions to address accreditation bodies’ noncompliance with survey requirements, or 3) determine whether OTPs complied with the federal standards when patient charts were incomplete. OIG recommends five steps to improve SAMHSA’s oversight.

UPCOMING HEARINGS

Senate

·       None of note

House 

·        None of note

OTHER HEALTH POLICY NEWS 

·       On March 10, the White House Domestic Policy Council Director Joe Grogan penned an op-ed in the Wall Street Journal outlining the Administration’s principals for drug pricing legislation, including to 1) cap OOP expenses in Part D; 2)  provide an option to cap monthly pharmacy costs; 3) offer protection against the cost cliff created by the ACA; 4) Give PDPs an incentive to negotiate better prices for costly drugs; and 5) limit drugmakers’ price increases. Grogan claims elements of each principle are reflected in the SFC’s drug bill (S.2543) and the House GOP drug package (H.R.16).

·       On March 9, Colorado sent HHS a plan to import prescription drugs from Canada using a third-party importer. For the drugs identified for importation, Colorado estimates their plan would result in a ​61% average price reduction​ compared to current U.S. prices. In total, they estimate the plan would save between $36 million to $60 million per year. Since Canadian officials have been wary of U.S. importation, Colorado has proposed several measures to encourage Canadian suppliers to participate.

·       On March 12, Washington Gov. Jay Inslee (D) signed two heath care bills into law. The first limits OOP costs for insulin to $100 for a 30-day supply. The second creates a prescription drug affordability board charged with determining whether the cost of a drug significantly exceeds its value. Starting in 2021, if the five-member board rules the list price of a drug indeed exceeds its value, then they will request for the manufacturer to lower it and, if necessary, post what the drug is actually worth online.  The legislature also passed a bill to extend Medicaid coverage to women up to a year after they give birth. 

·       On March 12, the Virginia legislature passed a bill to ban providers from sending surprise medical bills to patients. Modeled after Washington’s surprise billing fix, the legislation would require insurers to offer out-of-network providers "commercially reasonable" rates. If the providers do not accept and negotiation fails, then an arbiter would step in.